An image of a pile of mixed bread and rolls.

Gluten Intolerance, Celiac Disease, and the Leaky Gut Connection

by Dr. Matt Olesiak, M.D.

Gluten intolerance is an increasingly common condition affecting an estimated six to seven percent of the U.S. population or around 20,000 Americans. (1)

Another 1% of the population - one in 133 Americans -- have Celiac disease. However, the prevalence is likely much higher as gluten intolerance is a notoriously misdiagnosed or undiagnosed condition.

Because research suggests that unaddressed gluten intolerance may lead to the development of another increasingly common condition - leaky gut syndrome -- this is a bigger problem than we thought and needs to be solved.

In this guide, we'll discuss the types of gluten intolerance, the symptoms of each, and how it may increase your risk for a leaky gut.

Gluten Intolerance, Celiac Disease, and the Leaky Gut

An image of a young woman on a gluten-free diet refuses toast in a cafe.

What is Gluten?

Gluten is a protein found in wheat, rye, and barley. It is present in a wide variety of foods, including:

Bread
Cereals
Pasta
Pastries
Beer

What is Gluten Intolerance?

Gluten intolerance is when the body does not digest gluten well. As a result, those with this condition usually experience adverse reactions after ingesting gluten.

Types of Gluten Intolerance

There are three types of gluten intolerance: gluten sensitivity, wheat allergy, and Celiac disease. Let's take them one by one.

Gluten Sensitivity

Gluten sensitivity, also called non-celiac gluten sensitivity (NCGS), is a condition in which gluten consumption hurts the body, but it's not an autoimmune disorder or an allergy.

The symptoms may include:

Bloating
Headache
Diarrhea
Constipation
Depression
Anxiety
Fatigue
Joint pain
Brain fog
Numbness and tingling in the arms and legs

If you regularly experience one or more of these symptoms after consuming gluten, you may be intolerant of this type of protein.

Diagnosing Gluten Sensitivity

As there are no biomarkers for non-celiac gluten sensitivity, diagnosis is usually based on symptoms experienced within a few hours of gluten exposure and perhaps a few lab tests to rule out other conditions.

To confirm that gluten is the culprit, the doctor or dietitian may recommend an elimination or rotation diet in which you eliminate certain wheat products and other gluten-containing grains to see if your symptoms improve.

Then you'll add foods back to your diet to see which ones trigger your symptoms.

Your healthcare provider will almost certainly test for celiac disease, as its symptoms are similar. (Please see the description in the appropriate section below.)

In addition, your doctor will probably order tests to rule out other causes of the symptoms.

An image of ripe wheat stalks in a field.

Wheat Allergy

A wheat allergy is a condition in which the immune system has an abnormal reaction to any of the proteins found in wheat, including gluten.

More children than adults have wheat allergies, but most typically outgrow it by puberty. (3)

Symptoms can include:

Hives
Rash
Swelling of the mouth or throat
Nasal congestion
Bloating
Indigestion
Abdominal pain
Headache
Difficulty breathing
Nausea or vomiting

If you or your child experience severe symptoms after eating wheat, please seek medical treatment immediately.

Diagnosing Wheat Allergy

According to the Mayo Clinic (4), to diagnose a wheat allergy, your doctor will give you a physical exam, take a detailed medical history, and probably ask you to keep a food diary to see if any gluten-containing foods trigger an allergic reaction.

(Along with the food diary, you'll probably also remove certain foods to see if symptoms clear up, and then add them back in to see if the symptoms return.)

In addition, your doctor may order a few diagnostic tests, including:

Skin Test

This is a standard allergy test in which the doctor or nurse pricks allergen extracts -- including wheat proteins -- onto your skin.

In about 15 minutes, they'll check your skin for an allergic reaction. For example, if you develop an itchy skin rash at the location of the skin prick, you may have a wheat allergy.

Blood Test

If for some reason, you are not a candidate for a skin test, your doctor may order a blood test that detects specific allergy-causing antibodies for wheat proteins.

Infographic Text

Symptoms: abdominal distension, diarrhea, constipation, weight change, mouth ulcers, fatigue, nausea, acne, dermatitis, joint pain, dry skin, brittle nails, irregular menstruation, convulsion.

End Infographic Text

Celiac Disease

Celiac disease, the most severe form of gluten intolerance, is an autoimmune disorder that can damage the digestive system.

Specifically, when someone with celiac disease eats something containing gluten, their immune system overreacts to the protein and attacks the intestinal lining.

Eventually, its assault can cause intestinal damage, destroying the small intestine's ability to absorb nutrients from food properly.

The symptoms of celiac disease are wide-ranging and can include:

Fatigue
Diarrhea
Constipation
Depression
Anxiety
Skin conditions, including psoriasis
Malnutrition
Stunted growth
Iron-deficiency anemia (This is due to the reduced ability of the small intestine to absorb the iron from food.)
Muscle pain
Joint pain
Unintended weight loss

Celiac disease can also increase your risk of developing other autoimmune disorders.

An image of a book with stethoscope and pills with text that reads celiac disease.

Diagnosing Celiac Disease

Several options exist for diagnosing celiac disease.

Blood Tests

If you're allergic to gluten, your immune system will create specific antibodies to fight what it sees as a threat. (Remember, celiac disease is an autoimmune disorder.)

However, these antibodies will only be present if you eat gluten-containing foods. If blood testing indicates that you may have celiac disease, your doctor will probably take an endoscopy and a biopsy of your small intestine.

Endoscopy

Your doctor inserts a thin tube down your throat and into your small intestine in this procedure.

Using the tiny camera attached to the end of the tube, the doctor looks around to see if any damage has occurred in your digestive tract.

This procedure sounds scary and uncomfortable, but your doctor will give you a sedative drug to relax you and a local anesthetic to keep you from feeling anything.

Biopsy

During the endoscopy, small pieces of intestinal tissue will be removed and sent to the lab for analysis.

This biopsy detects the extent and type of damage, if any, that has occurred to the small intestine and other areas of the digestive tract.

Genetic Testing

Celiac disease is, to a great extent, inherited. Indeed, having a close family member with this disease significantly increases your risk.

Researchers have discovered the two genes related to this condition. Most people with celiac disease have at least one of these genes, and doctors can detect them with a simple cheek swab or saliva test.

Treating Gluten Intolerance

There is no known cure for gluten intolerance. But the condition can be managed by following a gluten-free diet. (5)

Removing all gluten from the diet is an essential step for those with celiac disease, as it's the only thing that can prevent further damage to the small intestine.

So, you’ll need to forego any food containing wheat, rye, and barley. This means avoiding all flour-containing foods, like pizza and pasta, and cutting out most prepared baked goods you find in stores. Beer is also out unless you opt for the gluten-free varieties.

Remember, too, that gluten is on the ingredient list of most processed foods, so you'll need to read the ingredient list carefully.

Though this sounds painfully restrictive, many products offer gluten-free varieties. Choose ones with labels that say "certified gluten-free" to ensure they are truly free of gluten and that there is no cross-contamination.

You may also choose to do your baking using naturally gluten-free ingredients like almond flour, coconut flour, and brown rice.

An image of a sign made with colorful background and white ceramic letters the spell gut health.

The Link Between Gluten Intolerance and Leaky Gut Syndrome

And finally, let's discuss the link between gluten intolerance and leaky gut syndrome.

Leaky gut is a condition of increased intestinal permeability. You see, your intestinal lining is semi-permeable, meaning it allows helpful substances to enter your digestive tract while preventing harmful substances from escaping into the bloodstream.

Tight junctions, tiny protein structures that line the intestines, are responsible for the integrity of the intestinal wall. If they are damaged, they no longer perform their jobs properly, allowing toxic substances to "leak" out and enter the bloodstream.

This can cause widespread inflammation increasing the risk for numerous health problems.

Conditions associated with the leaky gut syndrome include:

Chronic fatigue syndrome
Fibromyalgia
Asthma
Mood swings
Memory Loss
Depression
Anxiety
Inflammatory bowel disease
Irritable bowel syndrome
Autism
Food allergies
Arthritis
And many more

And guess what?

Several studies suggest that gluten consumption increases intestinal permeability. How? It activates zonulin, a protein that activates the tight junctions. When zonulin is released in the intestines, it tells the gates to open up wider and allow large particles to pass through the intestinal barrier. (6)

One study found that zonulin levels were much higher in those with celiac disease than those without. However, glutin has been shown to activate zonulin in everyone, whether gluten intolerant or not. (7)

This research suggests that high-gluten consumption may increase the risk of developing gluten intolerance.

The Microbiome

The microbiome also plays a significant role in leaky gut syndrome and gluten intolerance.

The community of microbes in the gut -- collectively called the microbiome -- are responsible for numerous functions in the digestive system and throughout the body.

There must be a precise balance of beneficial and harmful gut bacteria to support digestive and overall health. An imbalance in gut bacteria, called gut dysbiosis, can lead to intestinal inflammation.

Gastrointestinal inflammation can weaken the tight junctions, increasing intestinal permeability that weakens the tight junctions, eventually leading to a leaky gut.

And guess what? Gut dysbiosis appears to play a role in gluten intolerance.

For instance, several studies found that the guts of those with celiac disease contained increased numbers of harmful bacteria and decreased numbers of the beneficial kind compared to those without this disease.

So, it appears that gut health is vital to preventing gluten intolerance.

You can improve your gut health by eating a gluten-free, whole-food diet that contains plenty of nutrients, nonstarchy vegetables, high-quality protein, and whole-food fats.

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